title: Effect of increasing depth of dexmedetomidine and propofol anesthesia on upper airway morphology in children and adolescents with obstructive sleep apnea.
abstract: OBJECTIVE
  To examine the dose-response effects of dexmedetomidine (DEX) and propofol (PROP) on airway morphology in children and adolescents with a history of obstructive sleep apnea (OSA).
  
  
  METHODS
  Prospective, single-blinded, controlled comparative study.
  
  
  METHODS
  University-affiliated teaching hospital.
  
  
  METHODS
  60 patients with a history of OSA who presented for a magnetic resonance imaging (MRI) sleep study.
  
  
  METHODS
  Patients were randomized to two equal groups (DEX or PROP). Magnetic resonance images of the airway were obtained during low (1 μg/kg/hr) and high (3 μg/kg/hr) doses of DEX, or low (100 μg/kg/m) and high (200 μg/kg/m) doses of PROP, based on group assignment.
  
  
  METHODS
  The airway anteroposterior (AP) diameter, transverse diameter, and sectional areas were measured at the level of the nasopharyngeal airway and retroglossal airway. The influence of the two drugs and OSA severity, as determined by polysomnography, on airway dimensions was examined using mixed-effects analysis of covariance models.
  
  
  RESULTS
  Upper airway morphology was completed in 45 patients. Most airway measurements showed statistically nonsignificant associations with increasing doses of PROP and DEX. As the dosage increased, average airway dimensions were typically unchanged or slightly increased with DEX compared with airway dimensions that were unchanged or slightly decreased with PROP. An airway intervention was required in three children (11%) in the DEX group and 7 children (23%) in the PROP group (P = NS).
  
  
  CONCLUSIONS
  Both agents provided an acceptable level of anesthesia for MRI sleep studies in patients with OSA, with statistically nonsignificant changes in airway dimensions.
authors.affiliation: Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. Electronic address: mohamed.mahmoud@cchmc.org.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mahmoud
authors.forename: Dorothy
authors.initials: D
authors.lastname: Jung
authors.forename: Shelia
authors.initials: S
authors.lastname: Salisbury
authors.forename: John
authors.initials: J
authors.lastname: McAuliffe
authors.forename: Joel
authors.initials: J
authors.lastname: Gunter
authors.forename: Mario
authors.initials: M
authors.lastname: Patio
authors.forename: Lane F
authors.initials: LF
authors.lastname: Donnelly
authors.forename: Robert
authors.initials: R
authors.lastname: Fleck
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000758:Anesthesia / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology; D008279:Magnetic Resonance Imaging; D008297:Male; D017286:Polysomnography / Q000379:methods; D015742:Propofol / Q000008:administration & dosage* / Q000494:pharmacology; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol
keywords: Airway collapsibility; Airway obstruction; Dexmedetomidine; General anesthesia; Obstructive sleep apnea: pediatric; Propofol